Equipment Leasing Credit Application

Working Capital Credit Application

To complete the online application, the following details are required:
Company Information
Full Legal Company Name*
Doing Business As (DBA) - Trade Name (if applicable)
Company Website (if applicable)
Business Street Address, City, State & Zip*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.
Federal Tax ID Number*
Main Contact Information
Principal's Full Name*

First NameLast Name
Home Address, City, State, Zip*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Social Security Number*
Date of Birth*

MonthDayYear
Date
Is ownership of the business shared?*

YesNo
Percentage of Ownership*
Secondary Contact Information
Principal's Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid mobile phone number.
Email Address*
example@example.com
Social Security Number*
Date of Birth*

MonthDayYear
Select or enter your date of birth
Percentage of ownership (enter a number)*
Financial Information
Total Monthly Sales ($)*
Enter a dollar amount
Annual Gross Sales ($)*
Enter a dollar amount
Desired Funding Amount ($)*
Enter a dollar amount
Use of Funds*
How will funds be used?
Do you have a current Loan/Advance balance?*

YesNo
What is the remaining balance of your Loan/Advance?*
Enter a dollar amount
Who is your Loan/Advance held with?*
Acceptance & e-Signature
BUSINESS PURPOSE

You, the credit applicant, certify to us that you are applying for credit for a business purpose, and not for personal, family, or household purposes, and that the information you provided is true and correct.

USA PATRIOT ACT NOTIFICATION – The following notification is being provided to you pursuant to Part 326 of the USA Patriot Act of 2001, 31 CFR 103.121(b)(5):

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: When you open an account, including any deposit account, loan, lease, or extension of credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you. We may also ask to see your driver’s license or other identifying documents.

RELEASE & AUTHORIZATION

To Whom It May Concern: I authorize and request you to release information concerning my personal or business credit standing for this Credit Application, any renewals or future extensions of credit, or for review or collection of any resulting account. I authorize Craig Holdings, LLC DBA Lease Genie to share any such credit reports with its affiliates, assignees and potential funding partners.
Select Today's Date*

MonthDayYear
Date
Main Contact Signature*

Powered by Jotform SignClear
Secondary Guarantor’s Signature*

Powered by Jotform SignClear
Please verify that you are human*
Should be Empty:

Working Capital Credit Application

Company Information

Main Contact Information

Secondary Contact Information

Financial Information

Acceptance & e-Signature